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CMAJ • October 2, 2001; 165 (7)
© 2001 Canadian Medical Association or its licensors

Research
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Income-based drug benefit policy: impact on receipt of inhaled corticosteroid prescriptions by Manitoba children with asthma

Anita L. Kozyrskyj, Cameron A. Mustard, Mary S. Cheang and F. Simons

Dr. Kozyrskyj is with the Department of Community Health Sciences and the Manitoba Centre for Health Policy and Evaluation, Faculty of Medicine, University of Manitoba, Winnipeg, Man. Dr. Mustard is with the Department of Public Health Sciences, Faculty of Medicine, University of Toronto, and the Institute for Work and Health, Toronto, Ont. Ms. Cheang is with the Biostatistical Consulting Unit, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Man. Dr. Simons is with the Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Man.

Correspondence to: Dr. Anita Kozyrskyj, Manitoba Centre for Health Policy and Evaluation, S101-750 Bannatyne Ave., Winnipeg MB R3E 0W2; fax 204 789-3910; kozyrsk{at}cc.Umanitoba.CA

Background: Drug benefit policies are an important determinant of a population's use of prescription drugs. This study was undertaken to determine whether a change in a provincial drug benefit policy, from a fixed deductible and copayment system to an income-based deductible system, resulted in changes in receipt of prescriptions for inhaled corticosteroids by Manitoba children with asthma.

Methods: Using Manitoba's health care administrative databases, we identified a population-based cohort of 10 703 school-aged children who met our case definition for asthma treatment before and after the province's drug benefit policy was changed in April 1996. The effects of the program change on the probability of receiving a prescription for an inhaled corticosteroid and on the mean number of inhaled corticosteroid doses dispensed were compared between a group of children insured under other drug programs (the comparison group) and 2 groups of children insured under the deductible program: those living in low-income neighbourhoods and those living in higher-income neighbourhoods. All analyses were adjusted for a measure of asthma severity.

Results: For higher-income children with severe asthma who were covered by the deductible program, the probability of receiving an inhaled corticosteroid prescription and the mean annual number of inhaled corticosteroid doses declined after the change to the drug policy. A trend toward a decrease in receipt of prescriptions was also observed for low-income children, but receipt of prescriptions was unaltered in the comparison group. Before the policy change, among children with severe asthma, the mean annual number of inhaled corticosteroid doses was lowest for low-income children, and this pattern persisted after the change. Among children with mild to moderate asthma, those covered by the deductible program (both low income and higher income) were less likely to receive prescriptions for inhaled corticosteroids than those in the comparison group, and this difference was statistically significant for the higher-income children.

Interpretation: The change to an income-based drug benefit policy was associated with a decrease in the use of inhaled corticosteroids by higher-income children with severe asthma and did not improve use of these drugs by low- income children.




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